Heavy menstrual bleeding and cramping are the most common reasons why women stop using an intrauterine device (IUD) for birth control. A class of drugs (nonsteroidal anti-inflammatory drugs, or NSAIDs) reduces menstrual bleeding and cramping in women who are not using an IUD. These drugs, such as naproxen and ibuprofen, are sold over-the-counter as pain relievers in many countries. Hence, researchers have studied whether these same drugs might reduce bleeding and pain associated with use of intrauterine devices. This might lead to more comfortable use of IUDs for longer periods of time.
We searched for and summarized all the randomized controlled trials that looked at using these drugs to treat bleeding or pain related to an IUD. We also included trials that studied the use of these drugs to prevent these problems.
We found 15 trials from 10 countries, with more than 2700 women studied. These drugs reduced both bleeding and pain with intrauterine device use. Whether one drug is better than another was not clear. Similarly, the best dosing was not clear. Preventive treatment with these drugs around the time of IUD insertion had mixed results. No serious problems were reported, but stomach upset and sleepiness can occur with this class of drugs. Because of their safety, low cost, and wide availability, these drugs are appropriate treatment for women who have troublesome bleeding or pain with IUD use.